FreshRN05

this is exactly what I don't understand.....my patient was very much alert and oriented...she knows what's going on and even her vitals signs revealed that she's in pain...the doctor even said it himself that she's experiencing tolerance with her pain meds...sometimes I wanted to think that these doctors are not treating her fairly well because of the fact that she's on Medi-caid.....Why do they have to see it as patient abusing meds if indeed these doctors knew what kind of pain sickle cell can give you...

Yesterday at work, I was really worked up with one of my patients who has a sickle cell anemia..She's 24 years old and had been dealing with it since she was about 4 years old...According to the other nurses at my work, she's a frequent flyer and a non compliant with her care management...she comes to the hospital almost evey other month...she's been almost in all the med-surg floor in the hosptial and almost all nurses and doctors has dealt with her in the past...Yesterday was my first time to care for her...Anyhoo, this poor lady is in so much pain (mostly joints and back) that she's been asking for her pain medicine every 2 hours on the dot (Dilaudid 6 mg IVP every 2 hours, together with benadryl 50 mg IVP)...She complain that 6 mg is not giving her enough comfort that she's wanting more...Her reticulocyte is at 6 (indicative of crisis)..So, I placed a call to the admitting Doctor and stated 6 mg is more than enough, instead he gave her Norco 1 tab PO for breakthrough pain...but still she was not satisfied and was still in pain...She's also on IVF and refused oxygen...she sats 96% on RA...During the shift another Doctor came and assesed her and discontinued her Dilaudid IVP to VICODIN ES itab q 4 hours PRN and discontinued her IVF as well...I asked the Doctor and said that this patient is taking advantage and knows how to use the system and that the patient is noncompliant..so they are not going to tolerate it anymore and will nol onger give her any IV pain meds. He also stated that if the patient is not happy about how they manage her care, she can leave the hospital AMA and look for another provider. I was in shock and in dismay...The patient is in pain for crying out loud! I've learned from school that if someone's in pain, you don't question them...you have to acknowldege it..sure this patient might have been a frequent flyer but with this sickling disease that no cure hasn't been found..how can you just stand there and say enough is enough...

$23 per hour????????? Wow! That's so cheap! I've never done travel nursing but I know a lot of travel nurses from work and they get paid at least $50-60 per hour...You might need to research more and maybe find another company........just my penny!

Wow, that's a shame..but then again AUF has gained its reputation as one of the top nursing schools in the Philippines......I wonder though as to why they would not transfer your credits??? Here in the US, subjects are not bluntly rejected but needs to go through verification processing first. Did the Dean tell you why? Where in Pampanga are you from? I was born and raised there, then migrated here after HS. And by the way what made you decide to pursue your nursing studies there? Good luck to you!:caduceus:

ok, this one happened just last week...I had an order to start TPN/lipids on my patient...Our policy is to use two seperate pumps for the TPN and lipd and to use a filter for the TPN...Well, I did all the IV tubing connection and filter together and connected it to the patient's midline IV access...Well, it was going fine at first then few minutes later, the pumps were going crazy beeping and I tell you I spent a lot of time fixing and restarting the infusion but it just wouldn't stop beeping...I was going crazy and finally I called my Charge nurse and asked her to check it for me.....To my embarrassment, my CN told me that I had connected the lipid to the wrong connector that's why the machine kept beeping.....I had accidentally connected the Lipid above the filter (lipid is thick so the filter was having a hard time infusing)....luckily, my CN was so kind and told me that she had the same mistake when she was starting out as an RN....I felt so stupid....but I told myself "hey, that's how you learn"....

In the unit I work at (Med-Surg...mostly post op patients or awaiting for surgery) we sometimes do team nursing. If I have 10 patients, I will have an LVN and CNA working with me...The LVN will do all the PO meds and treatments (dressing change, F/C insertion, G-tube....) then the CNA will do all personal hygienes, vital signs, I/O's....I do all the assesments, IVP, IVPB, blood transfusion and calling Docs for critical labs and any changes in our patients status and clarifying and implementation of orders....Now, we also do TPC (total patient care), in this case we are only assigned 5 patients with a CNA no LVN...

when giving report ( we do ours via voicecare...not nurse-nurse) you do not have to give head-to-toe report on your patient. Focus on what the patient is in the hospital for and if there's any changes in his/her condition...This is how I do mine: 1) Patient's name, age, gender and Attending Doctor and any Consulting MD's 2) Diagnosis, medical history, allergies 3) mentation (a/o; nonverbal.......) 4) IVF, IVPB, any abnormal labs and vital signs 5) Pain status and pain control med 6) any treatments (dressings, NG tube, TPN's.......) 7) any pending or planned procedures (AM/PM labs, X-ray, CT's......) 8) diet and activities (regular, NPO, diabetic/renal duet; ambulatory with or with no assist (one on one or any assistive device) Just make it short and simple...Trust me, the nurse listening to your report only wants to know the important stuff...they don't wanna hear a long story.... I carry my report/assignment sheet with me to help me with my report at the end of the day. Hope this helps.....GOODLUCK

well....let's see....I'd say the first 3 months I was losing weight because of stress (I lost about 10-15 lbs in 3 months) but guess what???!!!!!! I'm gaining it back and fast (and more...)...I'm soooo hating it...I have wedding to attend to in September and I just can't seem to stop eating....I'm no longer as stressed at work anymore....my time management has improved to the point where I finally have time to eat at work......Yikes!!! I actually am going to joing 24-hour fitness next week.....

what I've heard is that this person works every wednesday and thursday AM 12-hour shifts and then every other weekend 12-hours night shifts. So say if this week she'll only work 2 days then next week 4 days.....She works in Skilled Nursing Facility as an RN (only RN on the floor with LVN's and CNA's under her) in charge of 80 residents............I'm thinking is it worth it?

Have you guys heard of this type of deal? Apparently a Skilled Nursing Facility in Palm Springs, CA has this type of deal where you work 2 12-hour shifts as an RN and get paid 40 hours. Such a too good to be true type of deal...Then you work every other weekend, which means every pay preiod you get a total of 120 hours...too bad I'm far from this City or else I would go and apply at that facility....But serioulsy though, is there such thing? If there is, how does it work and what's the catch??? I'm seriously wondering...Any feed back would be much appreciated....

alcohol swabs IV tubing caps pen light pens (red and black) pencil highlighter syringes sodium chloride bandaids tape kelly clamp bandage scissor mints cell phone (unit allowed) critical lab slips blank piece of paper

From an ADN community college in upstate NY......$18900.00........

Hi, Your post reply caught my attention about switching to a non bedside nursing...working for an insuance company. I too graduated in May 05 and I've been working in a med-surg tele unit for almost a year...but I am more interested in possibly working for an insruance company. See prior to nursing shool I was doing billing (claims) for a medical office and I must say I really enjoyed doing it ( because I had no direct patient contant, mostly contact was on the phone). So what do you do as a UR nurse? How did you get the job and how well do they pay? I'm really curious and interested.

Ok...I just have a question.....when doing team nursing, your team should work as a team right??? It doesn't matter if you're the RN, LVN, or the nurse tech as long as we all work together to have a smooth and well accomplished day...But...what if one of your team mates just don't want to work as a team? How do you set the line straight? I just had a very unfair day last week with my Nurse tech....she was constantly on herr breaks and long ones too and she's nowhere to be found when needed....I had to do her job on top of mine (answering call lights, assisting patients to the BSC, refilling ice pitchers, changing bed linens)...I ended up not having any of my breaks and working overtime because I was behind with my charting and IVPB's.....Luckily my LVN was there to help me whenever she can and the night nurse who took over was kind enough to hang my 1900 IVPB's. I had one situation where one patient needed to be changed and this nurse tech was getting ready to go on her 9 AM break and I told her when she get back to change this patient ( I was assessing my other patients at this time and checking all my orders and IV meds) and after 20-30 minutes she gets back and questioned me as to why this patient was never changed and why I had to wait for her ( I frozed because I hate confrontation and I'm new to the unit)..I guess my concern is, she should have at least made sure that all patients are clean and have everything they need (ice pitcher, linens changed, bed pan etc, vitals) before she go on her morning break....Being a leader is something new to me and I don't like telling people what to do....So, can you all suggest to me how to be an effective team leader without sounding like you're bossing everyone around? Is this Nurse tech trying to manipulate me just because I'm new and testing how far I would go? How do you handle this type of situation?

in my home unit (ER overflow with tele), we have 5:1 (sometimes with tech depending on our unit census)...when I float to other floors, it's 10:1 (non tele) with an LVN and a tech; 8:1 (tele) with an LVN and a Tech who is nowhere to be found.....

Hi, After what happened to me last night at work ( doing almost everything that my Nurse Tech should have done on top of my own responsibilities...hence not being able to take breaks and not able to get out in time) I came to realize that next time I come to work I will try to set my foot straight at the start of my shift and if I get to work with this aide again and she does the same thing, I will write her off or maybe tell my superior...maybe it's my mistake too for not saying anything to her but it was a mistake that I have learned the hard way and I promise myself not to let it happen again. I don't like to limit myself with my tasks just because I have an RN next to my name but hey there's a reason why we have team members and each member has to function within their own level of responsibilities...I don't mind wiping butts and changing linens but I have more important responsibilities that either an LVN or Nurse Tech are trained to do...Arggggggggg....I now feel the hard work I did yesterday...I woke up this morning with body sores (from lifting patients and running around like crazy at work yesterday):smackingf

Well....I've been off orientation for about a month now...I normally work in my home unit where we only care for 5 patients (total care) and our unit is an overflow of the ER (med-surg/tele)....I was doing fine until our unit temporarily closed due to low census of the hospital and bed control sends patients from ER directly to the med surg floor in the hospital...So since our unit was closed I had to float to the other floors....First day I was sent to the med-surg floor with 10 patients and I had an LVN and NT working with me...but still 10 patients...taking care of these patients was alright the only bad part of it is having to do all the documentations and then dealing with the families questions ( and the patients and the doctors...I work days by the way)...It was hell for me! But I survived it! Thank God! Second day, I was sent to med-surg/tele floor with 8 patients and an LVN and a Tech. after listening to the report and the PM nurse giving me update and telling me it was an easy round, I told myself "hmmmnnnn....nice"....But it was a different story after that! I had a patient who was on restraints ( elderly) and the PM nurse had given her Ativan and Haldol during their shift so the patient was out if it and was literally oversadated and lethargic...so I had to deal with her family and doctor as to why this patient is so "out of it" and to top it this patient was a s/p knee replacement. To make story short, the day was hell for me too because I had a NT who was lazy as hell...I didn;t get to take my 2 15 minute break and my lunch break because I was constantly getting interrrupted by call lights and having to help patients to the BSC and getting ice, turning and repositioning patients,blanket etc for them because my aide was hiding somewhere or taking breaks ( I mean frequent and long breaks)...But I do appreciate my LVN though coz she helped me out so much. I seriously didn't feel like I have accomplished so much patient care wise. I was just glad that I made sure that I stayed focus with thier medications and did not make any meds error (knock on wood) that day. I ahd very needy patients and falmiles and then Doctor coming in giving orders or asking how their patients were. There was a time where I was confused and just went brain fart. Thank God that these doctors were nice enough not to yell or get mad at me ( knock on wood again). Oh and I had to stay another hour because I was behind with my documentations and clearing patients IV's for the next shift and also giving reports...The following were my group of patients: 1) s/p knee replacement with hx of AFIB/elderly 2) GI bleed with mental retardation/obese ( 2 patients) 3) Brain abscess with ALOC 4) Appendicitits with sudden onset of 18 beats Vtach (non English speaking) 5) ESRD with BKA (receiving dialysis) 6) ESRD with uncontrollable hypotension 7) s/p cholecystectomy r/o DVT (PE) 8) chest pain s/p MVP

wow...i'm getting more and more excited as I get answers to my questions.....Organizational wise, I think it will not be a problem for I like things to be organized especially paper works....I just seem to notice though that in the hospital world getting organize is a bit of a challenge for you are always on the go...but I think when I start HH and the fact that I can take my work with me at home will be much of an advantage for me.....Now one more question (sorry) as far as getting orders from the doctor...how do you get it? do you call the doctor infront of the patient or do you take care of that once you're home? Does patients call you in the wee hours? or once you left their doors, you're done until the next visit (if you are to follow up on them)?

Hi, thank you for replying.......I actally was able to see the OASIS form and the way I see it, it maybe time consuming to fill out the the whole form but some of the questions are questions that I normally see when I get direct admit patient in the hospital where I work and I also open the care plan for each patient I admit at the hospital...Do you think this is something similar in the HH world? What about the billing part of the OASIS form, am I also repsonsible for completing and filling it out? I am actually a bit excited about it as I like one on one care with patients and the fact that I will do this when I want to not being stuck with a time clock. I am just hoping that I will like. What do you think are the major disadvantage of doing HH? I ask so much question for the reason that I want to be prepared when I start. Thank you again!

Thanks... I live in CA.....Can I ask you a question? What exactly do you do when you start a case? Any tips besides doing complete/comprehensive assessment?

I don't want to short change my self when I start HH...The agency that I will be working for will be paying me $100.00 per admission. HH is really new to me and I'd like to get some opinions from all you who are well experienced with HH..Here are some of my questions: 1) What is the fair pay for RN HH doing admission assessment/opening cases? 2) What other incentives should I be demanding from my agency ( ie gas, cell phone use, mileage)? 3) what benefits do they normally cover? 4) I know I have my own Prof Liability Insurance, but do HH cover you as well? 5) Working hours? On-calls, night calls? 6) Overtime with regards to completing paper works ( I heard OASIS is a pain in the hiney) 7) And as far as the CPT and ICD-9 codes, do we as RN's fill those out too or billing personnel in the agency takes care of that? 8) Lastly, what is the difference between RN and Case Manager when it comes to HH? If you do the admission does that mean you also become the case manager or agencies normally have these 2 separated? Any other things you can add is much appreciated ( so that I can bring this up to my manager before I start next weeK...you know, I don't want to be taken advantaged of just because I'm new to this field.) Thank you all!

thanks for the book suggestions..I have another question???? when you go out on the field to do HH...what things do you normally bring with you? (equipments, books etc) The HH agency that hired me only takes Geriatric patients and mostly under Medical/Medicare programs? What are the most important things I ned to bring with me everytime I go and see patients (besides my skills and compassion)..By the way, I'm only gonna be doing admission assessment (opening cases)...I'll be starting next week and I'm only doing this 1-2 x a week with max of 3 patients a day...What do you think? and what do you think of $100.00 per case? does this sound fair pay? Sorry one question turned out quite a few Thanks again!

any suggestions on home health books such as nursing care plan books??? gladly appreciate the help!

I feel the same as you...If I'm not mistaken...you're Filipino as well....Well, I am and just like you there are times that I feel shy and I feel like I don't belong with the group of people I work with....Patient care wise, I make sure I get my job done first before socializing with my coworkers. If I feel that my time with my patient is more impt than pleasing my coworkers by socializing with them. When time permits, I do sit down and chat with them (well, I must say it also depends on who my co workers are)....And hmnnnnnnn....and I alos noticed that I like it better socializing with non Filipinos than my coFilipinos.....I don't know but I just noticed that Filipinos tend to be more harsh especially if they have been in the business for quite a while....

"focus" is the same as problems or concern that you need to focus on your DAR...Funny 2 months ago I was in your position because I did'nt know how to write my Nurse Progress notes using the DAR format. I'm still learning though...sometimes I catch myself stuck on what to write. Some of the FOCUS ideas are: MOBILITY/ACTIVITY, ELIMINATION, PAIN, TRANSFER, PROCEDURE, NUTRITION, SAFETY, the list goes on and on.....you just have to know what you are focusing on....or you can also use some of the Nursing diagnoses that relates to your assessment findings...I just don't use it very much coz it's too long to write (he-he-he-he)...Let me know too if you come up with any ideas as I too am still learning...